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Also, the adverse cardiovascular safety in clinical trials before 2008 was evaluated based on populations that were not necessarily at high risk of cardiovascular disease and the follow-up duration was relatively short (usually less than 12 months)

Harno E, Cottrell EC, Yu A et al (2013) 11beta-Hydroxysteroid dehydrogenase type 1 (11beta-HSD1) inhibitors still improve metabolic phenotype in male 11beta-HSD1 knockout mice suggesting off-target mechanisms

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The studys limitations include its reliance on a US sample and a retrospective design, which may introduce bias and limit generalizability